Healthcare Provider Details

I. General information

NPI: 1245217959
Provider Name (Legal Business Name): RAYMOND CHRISTOPHER GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 NORTHERN AVE
ROCKFORD IL
61107-5309
US

IV. Provider business mailing address

1021 N MULFORD RD
ROCKFORD IL
61107-3877
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-9700
  • Fax: 815-394-1401
Mailing address:
  • Phone: 815-391-1000
  • Fax: 815-394-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036093873
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036093873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: